Liver 4 Flashcards
Most common clinical presenting sign in Budd Chiari syndrome?
ascites
abdomen gets distended with ascitic fluid
Most frequent causes of Budd Chiari Syndrome?
myeloprolifertive disorders like polycythemia vera
Most common benign liver tumors?
hemangiomas
more common in women
Kassabach-Merrit syndrome?
thrombocytopenia
consumptive coagulopathy
assc w/ hemangiomas
When do we resect hemangiomas?
when assc/ w Kassabach-Merrit syndrome; change in size; rupture
What liver lesion is this?
vividly enhances on arterial phase
rapid washout
elevated alpha fetoprotein
These lesions found in women 20-40 yrs age who take OCP;
adenomas
Whats the concern with adenomas?
risk of rupture
risk of malignant degeneration esp if > 5 cm in size
2nd most common benign liver tumor?
FNH
How does FNH present on CT imaging?
peripheral arterial enhancement
central stellate scar
What liver lesion has a central stellate scar?
FNH
This liver lesion shows peripheral nodular enhancement on arterial phase with progressive centripetal fill in portal venous phase:
hemangioma
Hydatid cysts caused by?
echinococcus granulosus
These cysts tend to have daughter cysts, with calcifications;
hydatid cysts
What do we worry about with hydatid cysts caused by echincocus?
rupture– >anaphylaxis
Tx for hydatid cysts?
antihelminthics pre and post op recommended
injection of alcohol or hypertonic saline–> kill scoloceles
Most common complication of percutaneous liver bx?
intraperitoneal hemorrhage
Bile leak occurs in 10% of pts after hepatectomy; how is it defined?
bilirubin is >3x normal bilirubin at around day 3
percutaneous drainage usually treats it
What’s the criteria for orthotopic liver transplant?
pts w/single lesion 2-5 cm in diameter + 2-3 tumors less than 3 cm each
without evidence of macro-vascular invasion or extra-hepatic disease
Absolute contraindications for liver bx?
pt inability to cooperate with procedure
can’t identify an adequate biopsy site
This refers to constellation of signs and symptoms related to obstruction of hepatic veins:
Budd Chiari syndrome
Diagnosis of BC syndrome?
duplex US
confirmed by angiography of hepatic veins and IVC
At what size cut off do hepatic adenomas need to be removed because of concern for malignant transformation and rupture?
5cm
Tx of choice for amebic liver abscesses?
metronidazole 500-750 mg 3x/day for 7-10 days
90% cure rate
Why is metronidazole effective for amebic liver abscesse
reaches high concentrations in the liver/intestines
How does hemangioma appear on US?
defined compressible mass
What’s FOLFOX?
5-FU
oxaliplatan
